Hello world, this week we continue our advocacy for patients suffering from epilepsy and or mental health disorders, by looking at the role can play in the management of such epileptics. Last week, we looked at the relationship between the two debilitating conditions, and it clear that there is a higher risk for epileptics to develop some mental disorder in the long run.
Role of the neurologist in the psychiatric management of patients with epilepsy
The article from Medscape we refer to, makes the following statements to this effect:
As neurologists, we tend to focus on seizure control, and psychiatric comorbidities are often underestimated. Recognizing psychiatric manifestations is an area that needs improvement.
Once symptoms are identified, the following questions arise:
- Are the symptoms related to the occurrence of seizures (preictal, ictal, postictal)?
- Are the symptoms related to AEDs?
- Is the onset of symptoms associated with the remission of seizures in patients who had previously failed to respond to AEDs?
Because of the phenomenology of epilepsy, the close association between epilepsy and psychiatry has a long history. The traditional approach to epilepsy care has been to focus on the seizures and their treatment. Concentrating only on the treatment of the seizures, which occupy only a small proportion of the patient’s life, does not seem to address many of the issues that have an adverse impact on the quality of life of the patient with epilepsy.
Sackellares and Berent stated that comprehensive care of the epileptic patient requires “attention to the psychological and social consequences of epilepsy as well as to the control of seizures.”
Although undoubtedly important in the care of the patient with epilepsy, advances in neurologic diagnosis and treatment tended to obscure the behavioral manifestations of epilepsy until Gibbs drew attention to the high incidence of behavioral disorders in patients with temporal lobe epilepsy.
Frequency of psychiatric disorders in patients with epilepsy
It is estimated that 2030% of patients with epilepsy have psychiatric disturbances.
Of patients with intractable complex partial seizures, 70% may have 1 or more diagnoses consistent with the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSMIIIR); 58% of these patients have a history of depressive episodes, 32% have agoraphobia without panic or other anxiety disorder, and 13% have psychoses. The risk of psychosis in patients with epilepsy may be 612 times that of the general population, with a prevalence of about 78%; in patients with treatment refractory temporal lobe epilepsy, the prevalence has been reported to range from 016%.
Differences in the rates may result from differences in the populations studied, time periods investigated, and diagnostic criteria.
The most common psychiatric conditions in epilepsy are depression, anxiety, and psychoses.
Factors in the development of psychosis
The following variables are believed to have particularly strong links to the development of psychotic phenomena in patients with epilepsy:
- Family history of psychosis: Patients who had a positive family history of psychosis were extremely susceptible to psychosis, so a genetic factor appears to be involved;
- Age at onset of epilepsy: Patients with interictal psychosis showed a significantly earlier onset of epilepsy;
- Type of seizure: The existence of complex partial seizure (mostly temporal lobe epilepsy) may be strongly associated with interictal psychoses;
- Intelligence: Patients with borderline intellectual functioning tend to develop psychotic symptoms relatively frequently.
The Neurologist as the most important caregiver in the entire epilepsy community, therefore has a big role to play to sensitize the patients and their families on such risks.
The Urgent need for sensitization in Cameroon
It is for such reasons that the Gbm Foundation is constructing the Gbm Centre for epilepsy and mental wellbeing, where knowledge sharing and continuous research could be carried out locally, nationally and internationally. Results coming in from the initial baseline studies commissioned in the Lebialem Division on the prevalence and perceptions about epilepsy and mental health, show that there is an urgent need for demystification of the conditions, sensitization and intensified advocacy for policy changes.